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Um S, Cope MR, Muir JA. Child anemia in Cambodia: A descriptive analysis of temporal and geospatial trends and logistic regression-based examination of factors associated with anemia in children. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002082. [PMID: 37713392 PMCID: PMC10503718 DOI: 10.1371/journal.pgph.0002082] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 08/16/2023] [Indexed: 09/17/2023]
Abstract
Anemia in children remains a public health concern in many resource-limited countries. To better understand child anemia in Cambodia, we examined temporal and geospatial trends of childhood anemia and used logistic regression to analyze its association with individual and household characteristics using data from the Cambodia Demographic and Health Surveys for 2005, 2010, and 2014. The prevalence of childhood anemia decreased from 62.2% in 2005 to 56.6% in 2014. The prevalence of childhood anemia was highest in Pursat (84.3%) for 2005, Kampong Thom (67%) for 2010, and Preah Vihear and Steung Treng (68.6%) for 2014. After adjusting for other variables, factors positively associated with childhood anemia included having a mother who was anemic (adjusted odds ratio (AOR) = 1.77, 95% CI: 1.58-1.97); being male vs. female (AOR = 1.20, 95% CI: 1.07-1.33), underweight (AOR = 1.24, 95% CI: 1.14-1.57), or stunted (AOR = 1.24, 95% CI: 1.09-1.41); or having had a recent episode of fever (AOR = 1.16, 95% CI: 1.03-1.31). Children were less likely to have anemia if they were older than 12 months. They were also less likely to have anemia if they were from a wealthier household (AOR = 0.64; 95% CI: 0.50-0.84) or had taken medications for intestinal parasites (AOR = 0.86; 95% CI: 0.89-0.93). These associations were generally consistent across time and space. Public health interventions and policies to alleviate anemia should be prioritized to address these factors across geospatial divides. Anemia remains highly prevalent among children aged 6-59 months in Cambodia.
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Affiliation(s)
- Samnang Um
- The National Institute of Public Health, Tuol Kork District, Phnom Penh, Cambodia
| | - Michael R. Cope
- Department of Sociology, Brigham Young University, Provo, Utah, United States of America
| | - Jonathan A. Muir
- The Global Health Institute, Emory University, Atlanta, Georgia, United States of America
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Masiakwala E, Nyati LH, Norris SA. The association of intrauterine and postnatal growth patterns and nutritional status with toddler body composition. BMC Pediatr 2023; 23:342. [PMID: 37415119 PMCID: PMC10324124 DOI: 10.1186/s12887-023-04155-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 06/24/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND Growth patterns may be indicative of underlying changes in body composition. However, few studies have assessed the association of growth and body composition in poorly resourced regions experiencing the double-burden of malnutrition exists. Thus, the aims of this study were to investigate the association of intrauterine and postnatal growth patterns with infant body composition at 2 years in a middle-income country. METHODS Participants were from the International Atomic Energy Agency Multicentre Body Composition Reference study. Fat mass (FM), fat free mass (FFM), Fat mass index (FMI), fat free mass index (FFMI), and percentage fat mass (%FM) were measured in 113 infants (56 boys and 57 girls), from Soweto, South Africa, using deuterium dilution from 3 to 24 months. Birthweight categories were classified using the INTERGROWTH-21 standards as small (SGA), appropriate (AGA), and large-for gestational age (LGA). Stunting (> -2 SDS) was defined using the WHO child growth standards. Birthweight z-score, conditional relative weight and conditional length at 12 and 24 mo were regressed on body composition at 24 mo. RESULTS There were no sex differences in FM, FFM, FMI and FFMI between 3 and 24 mo. SGA and AGA both had significantly higher %FM than LGA at 12 mo. LGA had higher FM at 24 mo. Children with stunting had lower FM (Mean = 1.94, 95% CI; 1.63-2.31) and FFM (Mean = 5.91, 95% CI; 5.58-6.26) at 12 mo than non-stunting, while the reverse was true for FFMI (Mean = 13.3, 95% CI; 12.5-14.2) at 6 mo. Birthweight and conditionals explained over 70% of the variance in FM. CRW at both 12 and 24 mo was positively associated with FM and FMI. CRW at 12 mo was also positively associated with FMI, while CH at 24 mo was negatively associated with both FFMI and FMI in boys. CONCLUSION Both LGA and SGA were associated with higher body fat suggesting that both are disadvantaged nutritional states, likely to increase the risk of obesity. Growth patterns through infancy and toddler period (1-2 years) are indicative of body fat, while growth patterns beyond infancy are less indicative of fat-free mass.
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Affiliation(s)
- Elizabeth Masiakwala
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, 7 York Rd, Parktown, Johannesburg, 2193, South Africa.
| | - Lukhanyo H Nyati
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, 7 York Rd, Parktown, Johannesburg, 2193, South Africa
- Interprofessional Education Unit, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, South Africa
| | - Shane A Norris
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, 7 York Rd, Parktown, Johannesburg, 2193, South Africa
- School of Human Development and Health, University of Southampton, Southampton, UK
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Konyole SO, Omollo SA, Kinyuru JN, Owuor BO, Estambale BB, Ritz C, Michaelsen KF, Filteau SM, Wells JC, Roos N, Friis H, Owino VO, Grenov B. Associations between Stunting, Wasting and Body Composition: A Longitudinal Study in 6- to 15-Month-Old Kenyan Children. J Nutr 2023; 153:970-978. [PMID: 36796480 DOI: 10.1016/j.tjnut.2023.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 12/23/2022] [Accepted: 02/08/2023] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND Early growth and body composition may influence the risk of obesity and health in adulthood. Few studies have examined how undernutrition is associated with body composition in early life. OBJECTIVES We assessed stunting and wasting as correlates of body composition in young Kenyan children. METHODS Nested in a randomized controlled nutrition trial, this longitudinal study assessed fat and fat-free mass (FM, FFM) using deuterium dilution technique among children at age 6 and 15 months. This trial was registered at http://controlled-trials.com/ (ISRCTN30012997). Cross-sectional and longitudinal associations between z-score categories of length-for-age (LAZ) or weight-for-length (WLZ) and FM, FFM, fat mass index (FMI), fat-free mass index (FFMI), triceps, and subscapular skinfolds were analyzed by linear mixed models. RESULTS Among the 499 children enrolled, breastfeeding declined from 99% to 87%, stunting increased from 13% to 32%, and wasting remained at 2% to 3% between 6 and 15 mo. Compared with LAZ >0, stunted children had a 1.12 kg (95% CI: 0.88, 1.36; P < 0.001) lower FFM at 6 mo and increased to 1.59 kg (95% CI: 1.25, 1.94; P < 0.001) at 15 mo, corresponding to differences of 18% and 17%, respectively. When analyzing FFMI, the deficit in FFM tended to be less than proportional to children's height at 6 mo (P ≤ 0.060) but not at 15 mo (P > 0.40). Stunting was associated with 0.28 kg (95% CI: 0.09, 0.47; P = 0.004) lower FM at 6 mo. However, this association was not significant at 15 mo, and stunting was not associated with FMI at any time point. A lower WLZ was generally associated with lower FM, FFM, FMI, and FFMI at 6 and 15 mo. Differences in FFM, but not FM, increased with time, whereas FFMI differences did not change, and FMI differences generally decreased with time. CONCLUSIONS Overall, low LAZ and WLZ among young Kenyan children were associated with reduced lean tissue, which may have long-term health consequences.
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Affiliation(s)
- Silvenus O Konyole
- Department of Nutritional Sciences, Masinde Muliro University of Science and Technology, Kakamega, Kenya.
| | - Selina A Omollo
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
| | - John N Kinyuru
- Department of Food Science and Technology, Jomo Kenyatta University of Agriculture and Technology, Juja, Kenya
| | | | - Benson B Estambale
- Division of Research, Innovations and Outreach, Jaramogi Oginga Odinga University of Science and Technology, Bondo, Kenya
| | - Christian Ritz
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Kim F Michaelsen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Suzanne M Filteau
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jonathan C Wells
- Childhood Nutrition Research Centre, Population, Policy and Practice Research and Teaching Department, University College London (UCL) Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Nanna Roos
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Henrik Friis
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Victor O Owino
- Nutritional and Health-Related Environmental Studies Section, Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Benedikte Grenov
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
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Sinha RK, Kumar P, Daniel A, Shah H, Sriswan R, Kokane A, Mohapatra A, Kashyap V, Goel AK, Kumar V, Kiran A, Arlappa N, Joshi A, Nayak RR, Sayal S, de Wagt A. Association between anthropometric criteria and body composition among children aged 6-59 months with severe acute malnutrition: a cross-sectional assessment from India. BMC Nutr 2022; 8:56. [PMID: 35739560 PMCID: PMC9219132 DOI: 10.1186/s40795-022-00551-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 06/14/2022] [Indexed: 12/01/2022] Open
Abstract
A multicentric study is being conducted in which children with severe acute malnutrition (SAM) aged 6–59 months are identified with only weight-for-height z-score (WHZ) < − 3 criteria. The present study aimed to assess associations of anthropometric parameters and body composition parameters, to improve treatment of SAM. We conducted a cross-section assessment using the enrolment data of children who participated in a multi-centric longitudinal controlled study from five Indian states. Fat-free mass (FFM) and fat mass (FM) were determined by bio-electrical impedance analysis (BIA). Six hundred fifty-nine children were enrolled in the study using WHZ < -3 criteria. Available data shows that WHZ, WAZ and BMIZ were significantly associated with FFMI while MUACZ was significantly associated with both FMI and FFMI. Children with both severe wasting and severe stunting had significantly lower FFMI compared to those who were only severely wasted. All forms of anthropometric deficits appear to adversely impact FFM and FM. Trial registration The study is registered with Clinical Trial Registration of India (Registration No.: CTRI/2020/09/028013 dated 24/09/2020).
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Affiliation(s)
- Rajesh Kumar Sinha
- National Centre of Excellence for Management of Children with Severe Acute Malnutrition (NCoE-SAM), Kalawati Saran Children's Hospital, C-604 Connaught Circus, DIZ Area, Connaught Place, New Delhi, 110001, India.
| | - Praveen Kumar
- Lady Hardinge Medical College and associated Kalawati Saran Children's Hospital, C-604 Connaught Circus, DIZ Area, Connaught Place, New Delhi, 110001, India
| | - Abner Daniel
- UNICEF India Country Office, 73, Lodi Estate, New Delhi, 110003, India
| | - Hemang Shah
- Children's Investment Fund Foundation, The Crescent, Level 3, Lado Sarai, New Delhi, 110030, India
| | - Raja Sriswan
- ICMR-National Institute of Nutrition, Beside Tarnaka Metro Station, Osmania University, Hyderabad, PO, Telangana-500007, India
| | - Arun Kokane
- All India Institute of Medical Sciences, Bhopal Saket Nagar, AIIMS Campus, Saket Nagar, BaghSwaniya, Bhopal, Madhya Pradesh-462020, India
| | - Aditya Mohapatra
- Addl Director, Department of Health and Family Welfare, Government of Odisha Annex Building, SIHFW, Bira Maharana Ln, Nilakantha Nagar, Nayapalli, Bhubaneswar, Odisha-751012, India
| | - Vivek Kashyap
- Rajendra Institute of Medical Sciences, Ranchi, Jharkhand-834001, India
| | - Anil Kumar Goel
- All India Institute of Medical Sciences, Raipur Gate No, 1, Great Eastern Rd, opposite Gurudwara, AIIMS Campus, Tatibandh, Raipur, Chhattisgarh-492099, India
| | - Virendra Kumar
- Lady Hardinge Medical College and associated Kalawati Saran Children's Hospital, C-604 Connaught Circus, DIZ Area, Connaught Place, New Delhi, 110001, India
| | - Asha Kiran
- Rajendra Institute of Medical Sciences, Ranchi, Jharkhand-834001, India
| | - N Arlappa
- ICMR-National Institute of Nutrition, Beside Tarnaka Metro Station, Osmania University, Hyderabad, PO, Telangana-500007, India
| | - Ankur Joshi
- All India Institute of Medical Sciences, Bhopal Saket Nagar, AIIMS Campus, Saket Nagar, BaghSwaniya, Bhopal, Madhya Pradesh-462020, India
| | - Rashmi Ranjan Nayak
- Joint Secretary, Department of Women and Child Development and Mission Shakti, Government of Odisha, Mission Shakti Bhawan, At-Gandamunda, PO-Baramunda, Bhubaneswar, Odisha, Pin-751030, India
| | - Shikha Sayal
- National Centre of Excellence for Management of Children with Severe Acute Malnutrition (NCoE-SAM), Kalawati Saran Children's Hospital, C-604 Connaught Circus, DIZ Area, Connaught Place, New Delhi, 110001, India
| | - Arjan de Wagt
- UNICEF India Country Office, 73, Lodi Estate, New Delhi, 110003, India
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Tello B, Rivadeneira MF, Moncayo AL, Buitrón J, Astudillo F, Estrella A, Torres AL. Breastfeeding, feeding practices and stunting in indigenous Ecuadorians under 2 years of age. Int Breastfeed J 2022; 17:19. [PMID: 35248108 PMCID: PMC8898506 DOI: 10.1186/s13006-022-00461-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 02/14/2022] [Indexed: 12/29/2022] Open
Abstract
Background The indigenous child population in Ecuador has a high prevalence of stunting. There is limited evidence of the association between breastfeeding, feeding practices, and stunting in indigenous children. This study aimed to analyze the prevalence of breastfeeding and complementary feeding practices and explore their association with stunting in Ecuadorian indigenous children under two years of age. Methods Cross-sectional study of secondary data analysis using the 2012 Ecuador National Health and Nutrition Study, in 625 children aged 0–23 months (48,069 expanded sample), representative for the indigenous population. Breastfeeding and complementary feeding indicators were analyzed by age groups. Timely initiation of breastfeeding (within one hour after birth), exclusive breastfeeding (infants under six months who received only breast milk for the previous day), and other indicators were measured. Chi-square test or Fisher's exact test and logistic regression for complex samples were used to explore association with demographic and socioeconomic factors and stunting. Results Twenty-six-point eight percent of the children were stunted. Stunting occurred mainly in children with rural residence, on poor households, and where there were four or more children. Most of the children had a timely initiation of breastfeeding (69.5% for 0–12 months and 75.5% for 13–23 months) and exclusive breastfeeding up to six months (78.2%). Among children between 6–12 months of age, 99.3% continued to be breastfed. In children from ages 6 to 12 months, 32.5% received food with adequate dietary diversity. Lower percentages of complementary feeding occurred in the poorest, adolescent mothers or those with less education. Children who did not receive the minimum frequency of meals for their age had higher odds of stunting (OR 3.28; 95% CI 1.3, 8.27). Children from age 19 to 23 months who consumed foods rich in iron showed lower probabilities of stunting (OR 0.04; 95% CI 0.00, 0.51). Conclusions Breastfeeding practices reached a prevalence of 70% or more, without being associated with stunting. Complementary feeding practices showed differences by socioeconomic condition. Not reaching the minimum meal frequency between 6 and 12 months of age was associated with stunting. Plans and strategies are necessary to promote adequate feeding and breastfeeding practices in the indigenous population. Supplementary Information The online version contains supplementary material available at 10.1186/s13006-022-00461-0.
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Oliveira-Junior G, Pinto RS, Shirley MK, Longman DP, Koehler K, Saunders B, Roschel H, Dolan E. The Skeletal Muscle Response to Energy Deficiency: A Life History Perspective. ADAPTIVE HUMAN BEHAVIOR AND PHYSIOLOGY 2022. [DOI: 10.1007/s40750-021-00182-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Windus JL, Burrows TL, Duncanson K, Collins CE, Rollo ME. Scoping review of nutrition intervention and dietary assessment studies in Khmer populations living in Cambodia. J Hum Nutr Diet 2021; 34:953-968. [PMID: 34231266 DOI: 10.1111/jhn.12932] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 06/04/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND This scoping review aims to describe the body of nutrition intervention and dietary assessment research undertaken with Khmer populations in Cambodia, as well as summarise the nutrition knowledge base and highlight priority areas for future research. METHODS Five databases and the grey literature were searched, following PRISMA-ScR guidelines. Studies involving dietary assessment or nutrition interventions published after 1992 were identified using specific search terms and extracted to a customised data extraction table for categorisation and analysis. Study participants were Khmer people of any age and gender, living in rural or urban Cambodia. RESULTS Of the 100 included studies, 58 were dietary assessment only studies, 24 were nutrition interventions only, and 18 studies involved both assessment of intake and an intervention. Sixty-eight percent of study populations were mothers and young children, of which 52 studies focused on children aged under 5 years. Nineteen interventions involved supplementation and six trialled fortification of rice or fish sauce. Anaemia was the most common nutrition condition studied (n = 17), followed by malnutrition (n = 15) and malnutrition risk factors (n = 11). General nutrition status was explored in 25 studies, and individual micronutrients that were studied included iron (n = 27), zinc (n = 6), vitamin A (n = 4) and thiamine (n = 3). CONCLUSIONS Diet-related research in Khmer populations in Cambodia has predominantly focused on dietary assessment or evaluation of interventions aimed at reducing malnutrition and resolving micronutrient deficiencies. Areas identified as emerging needs included non-communicable diseases, the ageing population and non-iron deficiency anaemia.
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Affiliation(s)
- Janelle L Windus
- Faculty of Health and Medicine, School of Health Sciences University of Newcastle, University Drive, Callaghan, NSW, Australia
| | - Tracy L Burrows
- Faculty of Health and Medicine, School of Health Sciences University of Newcastle, University Drive, Callaghan, NSW, Australia
| | - Kerith Duncanson
- Faculty of Health and Medicine, School of Health Sciences University of Newcastle, University Drive, Callaghan, NSW, Australia
| | - Clare E Collins
- Faculty of Health and Medicine, School of Health Sciences University of Newcastle, University Drive, Callaghan, NSW, Australia
| | - Megan E Rollo
- Faculty of Health and Medicine, School of Health Sciences University of Newcastle, University Drive, Callaghan, NSW, Australia
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8
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Fabiansen C, Cichon B, Yaméogo CW, Iuel-Brockdorf AS, Phelan KPQ, Wells JC, Ritz C, Filteau S, Briend A, Christensen VB, Ashorn P, Michaelsen KF, Shepherd S, Friis H. Association between admission criteria and body composition among young children with moderate acute malnutrition, a cross-sectional study from Burkina Faso. Sci Rep 2020; 10:13266. [PMID: 32764545 PMCID: PMC7413376 DOI: 10.1038/s41598-020-69987-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Accepted: 07/20/2020] [Indexed: 12/03/2022] Open
Abstract
Children with moderate acute malnutrition (MAM) are treated based on low weight-for-length z-score (WLZ), low mid-upper arm circumference (MUAC) or both. This study aimed to assess associations of admission criteria and body composition (BC), to improve treatment of MAM. We undertook a cross-sectional study among 6–23 months old Burkinabe children with MAM. Fat-free (FFM) and fat mass (FM) were determined by deuterium dilution and expressed as FFM (FFMI) and FM index (FMI). Of 1,489 children, 439 (29.5%) were recruited by low MUAC only (MUAC-O), 734 (49.3%) by low WLZ and low MUAC (WLZ-MUAC) and 316 (21.2%) by low WLZ only (WLZ-O). Thus, 1,173 (78.8%) were recruited by low MUAC, with or without low WLZ (ALL-MUAC). After adjustments, WLZ-O had 89 g (95% confidence interval (CI) 5; 172) lower FFM compared to MUAC-O. Similarly, WLZ-O had 0.89 kg/m2 (95% CI 0.77; 1.01) lower FFMI compared to MUAC-O, whereas there was no difference for FMI. However, boys included by WLZ-O compared to MUAC-O had 0.21 kg/m2 (95% CI 0.05; 0.38) higher FMI. In contrast, girls included by WLZ-O had 0.17 (95% CI 0.01; 0.33) kg/m2 lower FMI compared to MUAC-O (interaction, p = 0.002). We found that different criteria for admission into MAM treatment programmes select children with differences in BC, especially FFMI. Trial registration: ISRCTN42569496.
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Affiliation(s)
- Christian Fabiansen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Rolighedsvej 25, 1958, Frederiksberg, Denmark. .,Médecins Sans Frontières-Denmark, Dronningensgade 68, 3, 1420, Copenhagen, Denmark.
| | - Bernardette Cichon
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Rolighedsvej 25, 1958, Frederiksberg, Denmark.,Médecins Sans Frontières-Denmark, Dronningensgade 68, 3, 1420, Copenhagen, Denmark
| | - Charles W Yaméogo
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Rolighedsvej 25, 1958, Frederiksberg, Denmark.,Département Biomédical et Santé Publique, Institut de Recherche en Sciences de la Santé, Ouagadougou 03, BP 7047, Bobo-Dioulasso, Burkina Faso
| | - Ann-Sophie Iuel-Brockdorf
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Rolighedsvej 25, 1958, Frederiksberg, Denmark.,Médecins Sans Frontières-Denmark, Dronningensgade 68, 3, 1420, Copenhagen, Denmark
| | | | - Jonathan C Wells
- Childhood Nutrition Research Centre, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Christian Ritz
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Rolighedsvej 25, 1958, Frederiksberg, Denmark
| | - Suzanne Filteau
- London School of Hygiene and Tropical Medicine, Faculty of Epidemiology and Population Health, Keppel Street, London, WC1E 7HT, UK
| | - André Briend
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Rolighedsvej 25, 1958, Frederiksberg, Denmark.,Center for Child Health Research, Tampere University, Faculty of Medicine and Health Technology and Tampere University Hospital, Lääkärinkatu 1, 33014, Tampere, Finland
| | - Vibeke B Christensen
- Médecins Sans Frontières-Denmark, Dronningensgade 68, 3, 1420, Copenhagen, Denmark.,Department of Paediatrics and Adolenscent Medicine, Blegdamsvej 9, 2100, RighospitaletCopenhagen, Denmark
| | - Per Ashorn
- Center for Child Health Research, Tampere University, Faculty of Medicine and Health Technology and Tampere University Hospital, Lääkärinkatu 1, 33014, Tampere, Finland
| | - Kim F Michaelsen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Rolighedsvej 25, 1958, Frederiksberg, Denmark
| | - Susan Shepherd
- ALIMA, Route de l'Aéroport, Rue NG 96, BP 15530, Dakar, Sénégal
| | - Henrik Friis
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Rolighedsvej 25, 1958, Frederiksberg, Denmark
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Wells JCK. Body composition of children with moderate and severe undernutrition and after treatment: a narrative review. BMC Med 2019; 17:215. [PMID: 31767002 PMCID: PMC6878632 DOI: 10.1186/s12916-019-1465-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 11/08/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Until recently, undernourished children were usually assessed using simple anthropometric measurements, which provide global assessments of nutritional status. There is increasing interest in obtaining more direct data on body composition to assess the effects of undernutrition on fat-free mass (FFM) and its constituents, such as muscle and organs, and on fat mass (FM) and its regional distribution. MAIN TEXT Recent studies show that severe-acute undernutrition, categorised as 'wasting', is associated with major deficits in both FFM and FM that may persist in the long-term. Fat distribution appears more central, but this is more associated with the loss of peripheral fat than with the elevation of central fat. Chronic undernutrition, categorised as 'stunting', is associated with deficits in FFM and in specific components, such as organ size. However, the magnitude of these deficits is reduced, or - in some cases - disappears, after adjustment for height. This suggests that FFM is largely reduced in proportion to linear growth. Stunted children vary in their FM - in some cases remaining thin throughout childhood, but in other cases developing higher levels of FM. The causes of this heterogeneity remain unclear. Several different pathways may underlie longitudinal associations between early stunting and later body composition. Importantly, recent studies suggest that short children are not at risk of excess fat deposition in the short term when given nutritional supplementation. CONCLUSION The short- and long-term functional significance of FFM and FM for survival, physical capacity and non-communicable disease risk means that both tissues merit further attention in research on child undernutrition.
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Affiliation(s)
- Jonathan C K Wells
- Childhood Nutrition Research Centre, Population, Policy and Practice Research and Teaching Department, University College London (UCL) Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK.
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